About healthycaregiver

I took care of my husband for 10 years while he had earlier-onset Alzheimer's disease. My experience, along with my expertise as a wellness coach and health writer, prompted me to write a book on how caregivers can maintain their health, increase energy, and experience peace. My book "Calmer Waters: The Caregivers' Journey Through Alzheimer's and Dementia" will be released in June, 2016 by Cardinal Publishing Group. Please follow my blog for caregiving advice and the latest scientific studies on staving off dementia and supporting cognitive function.

A Vegetarian Holiday Feast

Homemade apple pie with nuts and pumpkin seeds.I’ve been a vegetarian since 1971—my entire adult life. I’ve never had a problem eating Thanksgiving dinner. I just avoid the turkey and make a veggie dish containing protein. The benefit is that, although tryptophan—the essential amino acid in turkey—won’t be surging through my body to promote serotonin, the feel-good neurotransmitter—I will be getting more antioxidants and fiber than most people enjoying the holiday feast.

Whether you eat turkey or not, are a vegetarian or not, here are some great veggie dishes worth trying. I’ve listed them in order from appetizer, salad, muffins, entree, side dishes, and dessert to make a complete vegetarian Thanksgiving/holiday feast.

These two appetizer recipes are a throwback to the 70s. They are still delicious! Serve before your feast, while you are busy in the kitchen with final preparations. All recipes are gluten-free except for the pumpernickel dip, which can be made gluten-free if the dip is put into a bowl or gluten-free hollowed out bread.

Appetizers

Artichoke Dip

  • 1 can artichokes, drained and cut into small pieces.
  • 1 cup mayonnaise
  • 1 cup Parmesan cheese
  • 1/4 tsp garlic powder

Directions

  1. Blend all ingredients together.
  2. Sprinkle paprika on top. Bake at 350 for 20 minutes.
  3. Serve with crackers, veggies, etc.

Pumpernickel dip

  • 3 cups sour cream (1 large container) or plain Greek yogurt
  • 3 cups mayonnaise
  • 4 tsps dried dill weed
  • 1 tsp. salt (or to taste)
  • 1 tsp. celery seed
  • 4 Tbs. dried onion flakes
  • 4 Tbs dried parsley flakes

Directions

  1. Blend together and refrigerate overnight or for several hours so flavors blend.
  2. Scoop out the center of a round pumpernickel or sour dough bread. Fill with the dip.
  3. Serve with raw veggies that can be dipped into the bread.

Salad

Green salad with “cutie” mandarin oranges—serves 4-6

  • 1 or 2 heads of Butterhead lettuce
  • 3 mandarin sectioned oranges or 1 can of mandarin oranges, drained
  • 1/2 cup slivered almonds
  • 2 Tbs sugar
  • 1 cup celery, diced
  • sliced red onion (optional)

Dressing

  • 1/4 cup red wine vinegar
  • 1/2 cup olive oil
  • 1 tsp sugar
  • salt and pepper to taste
  • 1/8 tsp red pepper flakes

Directions

  1. In a large bowl, combine the lettuce, oranges, and sliced onions.
  2. Heat sugar and almonds in a pan over medium heat until sugar melts and coats almonds; stir and heat until almonds are slightly brown.
  3. Turn onto plate and cool for 10 minutes.
  4. Combine remaining ingredients in a jar with a tight fitting lid; shake vigorously.
  5. Pour salad dressing over lettuce mixture; toss.
  6. Sprinkle with sugared almonds.

Muffins

Gluten-free Flax Meal Muffins

  •  ¾ cup brown rice flour
  • ¾ cup buckwheat flour
  • ½ cup ground flaxseed
  • ½ cup date sugar (or sweetener of your choice)
  • 1 tsp baking soda
  • ½ tsp ground cinnamon
  • ¼ tsp ground nutmeg
  • ¼ tsp salt
  • ½ cup raisins
  • 2 eggs
  • ¼ cup oil of your choice (coconut, avocado, etc.)
  • 1/2 cup unsweetened applesauce
  • 1 cup buttermilk or coconut milk

Directions

  1. Preheat oven to 375º. Line a 12-cup muffin tin with unbleached paper liners and set aside.
  2. In a large bowl, whisk together brown rice flour, buckwheat flour, flaxseed, sweetener, baking soda, cinnamon, nutmeg, salt and raisins.
  3. In a second large bowl, whisk together eggs, oil, applesauce and buttermilk. Add flour mixture to buttermilk mixture and stir until just combined.
  4. Spoon batter into prepared muffin tins and bake until golden brown and a toothpick inserted in the center of a muffin comes out clean, about 30 minutes.
  5. Cool muffins in pan for 5 minutes before transferring to a wire rack to finish cooling.

Entree

Kale Slab Pie (adapted from a recipe by Arthi Subramaniam)  serves 12

  • 3 bunches of kale—tear the leaves off the stems, or 2 pounds of Swiss chard
  • 1/3 cup olive oil
  • 2 medium onions, finely chopped
  • 1 bunch scallion, chopped
  • 1/2 cup chopped fresh dill
  • 1/2 cup chopped fresh mint
  • 1 tsp red pepper flakes
  • Freshly ground pepper to taste (divided)
  • 3 cups water
  • 2 cups coarsely ground cornmeal (polenta style)
  • 1 cup feta cheese, crumbled
  • 1 cup shredded mozzarella cheese
  • 1 cup pomegranate seeds for garnish

Directions

  1. Blanch kale leaves in salted boiled water for about 4 minutes. Transfer wilted greens to a bowl of cold water. Drain and squeeze out moisture. Chop and set aside.
  2. Heat 4 Tbs of olive oil over medium heat in a skillet, add onion. Cook, stirring until tender, about 8 minutes.
  3. Add scallions and cook for another 2 minutes. Stir in kale, dill and mint. Add red pepper flakes, and salt and pepper to taste, and combine well. (I don’t add salt because I think there’s another salt in the cheese.) Remove from heat and let kale mixture cool.
  4. Preheat oven to 350 degrees and grease a 13-by-9pinch rectangular pan with remaining oil (1 Tbs plus 1 tsp.)
  5. In a medium saucepan, bring water to a boil. Gently and slowly add polenta and 1-2 tsp. of salt. Stir continuously so it doesn’t lump until thick. Spread in the pan, like a crust.
  6. Add feta and mozzarella cheese to kale mixture; lightly combine well. Spread evenly over the polenta crust. Cover the dish with foil, loosely, and bake 30 minutes. Remove foil and bake an additional 15-20 minutes, until top is slightly brown. Remove from oven and allow to sit for 30 minutes. Garnish with the pomegranate seeds. Allow the slab pie to “rest” for about 30 minutes before serving.

Veggie side dish

Roasted Cauliflower  serves 6

  • 2 heads cauliflower cut into florets
  • 1/2 cup olive oil
  • 1 tsp dried thyme
  • 1/2 tsp salt
  • 1/2 tsp pepper
  • 2 Tbs pine nuts
  • 1/2 cup raisins soaked in hot water

Directions

  • Preheat oven to 450 degrees.
  • In a large bowl, toss cauliflower, 1/4 cup olive oil, curry powder, salt and pepper. Spread onto a pan and roast for 10 minutes. Toss and then roast another 10 minutes until slightly golden, about 2 minutes.
  • Toast the pine nuts in a toaster oven, making sure to keep an eye on them so they don’t burn. Drain the raisins. Toss the cauliflower with the pine nuts and cauliflower.

Side dish

Butternut Squash Risotto serves 4

  • 1 butternut squash baked and scooped
  • 2 Tbs olive oil
  • 1 tsp salt
  • 1/2 tsp black pepper
  • 6 cup of vegetable stock or water
  • 6 Tbs unsalted butter
  • 2 large shallots, minced
  • 1 1/2 cups of Arborio rice
  • 1/2 cup of white wine
  • 1 tsp saffron threads
  • 1 cup of grated parmesan
  • Heat oven to 450 degrees. Peel squash and cut into cubes, discarding stringy center and seeds. Toss with olive oil and salt and pepper. Place on baking sheet and roast 30 minutes. Set aside.

Directions

  1. Heat stock and simmer.
  2. In a large pot, melt butter and add shallots for 10 minutes. Add rice and coat with butter.
  3. Add wine and cook 2 minutes.
  4. Add 2 full ladles of stock to rice plus saffron, 1 tsp. salt and 1/2 tsp pepper. Stir and simmer until stock is absorbed. Continue to add stock until almost all is used, cooking about 30 minutes.
  5. Turn off heat and add squash and Parmesan cheese.

For dessert enjoy apple pie, pumpkin pie or simple baked apples with ice cream.

Baked apples

Ingredients

  • 3 pounds apples peeled, cored, sliced (Honeycrisp, Gala, or Granny Smith, or a mixture of 2 or all 3)
  • 1/2 cup light brown sugar
  • 2 teaspoon ground cinnamon
  • 1/2 teaspoon ground nutmeg
  • 1/4 teaspoon ground cloves
  • 1/8 teaspoon salt
  • lemon juice from 1/2 a lemon
  • 1 teaspoon vanilla extract
  • 2 tablespoons unsalted butter

 

Directions

  1. Preheat the oven to 350 degrees.
  2. Peel the apples, cut and remove the core and cut into slices about 1/3-1/2 an inch thick.
  3. Put the apples to a large bowl and add the light brown sugar, cinnamon, nutmeg, cloves, salt, lemon juice and vanilla extract. Stir to combine. Spoon the apples into a 2 quart baking dish.
  4. Cut the butter into small squares, and place over the apples.
  5. Bake for 30 minutes, stirring after the apples have baked for 15 minutes. This prevents apples on the top from drying. Bake until the apples are tender and soft.
  6. Remove and serve with a scoop of vanilla ice cream on top. Serve warm.

Have a safe and wonderful Thanksgiving!

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and online at Target and Walmart, and many other fine independent bookstores, as well as public libraries.

10 Great Gifts for Caregivers

New Year's box with gifts and bows, fir cones, snowflakes and Christmas toy on old boardsIf you’re a caregiver, you have little time for yourself and you’re probably stressed out. You don’t need another pair of pajamas, and you don’t need another coffee mug.

What you desperately need is some time for yourself to relax and rejuvenate, and ways to make your life easier.

When friends and family ask you,” How can I help?” Or, “What do you need?” send them this list. They will appreciate it, and you will definitely appreciate the rewards.

  1. You know how wonderful it feels to have a sparkling clean house. And you probably haven’t had time to do a deep cleaning in a while. Ask your friends and neighbors for recommendations for a good house cleaner or cleaning service. Merry Maids is a national company available in most parts of the U.S. They also have gift cards online to make it convenient for your gift givers.
  2. Wouldn’t it be heavenly to get away for a few hours? It’s important to maintain friends throughout our lives, and even more important when we need to vent or just need a friendly chat or someone to tell you that you’re doing the best that you can. Gift cards to a neighborhood coffee shop or restaurant can help provide an excuse to connect to a friend you haven’t seen in a while. Make a date.
  3. But in order to make a date, you might need a companion to stay with your loved one. Providing TIME to you may be the greatest gift of all. Ask for a time donation, possibly in blocks of time. Two hours a week for a month? Four hours a month? Spread your wishes around. You’re bound to get several “yeses.”
  4. Do you like to sing? Whether you sing in the shower or in a chorus, it’s been well documented that singing reduces stress levels and depression. Group singing boosts oxytocin levels, and creates a feeling of “togetherness.” (Oxytocin is called the “love  hormone” because it is released when mothers breastfeed and when people snuggle up or bond socially. Request a favorite music CD that you like to sing to. Try to include the person you are caring for. Invite neighbors over for a singalong, and make it intergenerational. It’s amazing that people who even have advanced dementia can often remember the words to songs they sang decades ago.
  5. What about dance? You might have two left-feet, but you can dance away your blues without anyone watching in your living room. I always say that dance is what kept me off anti-depressant medication during the 10 years I cared for my husband. I did folk dance, salsa, and contra on a weekly basis. It was well worth the expense of hiring someone to keep my husband company on those evenings. Dance supports the release of endorphins from the brain into the bloodstream. I experienced firsthand a rush of happiness for hours, and sometimes days, after dancing for just a couple hours. Not only does dancing uplift your spirit, it can help you think more clearly. A 21-year-long Einstein Aging Study that was published in the New England Journal of Medicine in 2003 found that dancing is the best form of exercise to help prevent dementia when compared to 11 other activities including swimming, bicycling, and team sports. The study also found that dancing can help slow down cognitive decline. Dancing to music that carries special significance can be a wonderful way to connect with your care partner. Why not ask for a CD of your favorite music and dance in your living room, alone or with your care partner? Or, learn a new dance. Request a DVD to teach you the steps. Or, try a Zumba class. Fitness is a Latin-inspired cardio-dance workout that uses music and choreographed steps to form a fitness party atmosphere. While many of the types of dance and music featured in the program are Latin American inspired, classes can also contain everything from jazz to African beats to country to hip-hop and pop. Attend a Zumba class at your local recreation center or YMCA. They are also available on YouTube videos. And ask for a gift of companion-sitting for your loved one.
  6. House maintenance is often neglected when you have a million caregiving tasks. When is the last time you raked your lawn, pulled weeds, fixed a leaky sink, or had your carpets cleaned? The offer of someone volunteering their time to provide these services or the gift of a handyman service is always appreciated.
  7. Would you like to try a yoga class, either online or at a studio? Ask for a yoga mat, yoga blocks and a yoga strap. That’s all you need to help you release stress, build up endurance, relax muscles, and reduce risk of osteoporosis. Yoga videos are sold on Gaim, and are offered on their website for $11.99 per month after doing a free 2-week trial at https://www.gaia.com/yoga?utm_source=google+paid&utm_medium=cpc&utm_term=gaiam%20yoga&utm_campaign=1-USA-ENGLISH-BRAND-EXCT&utm_content=gaia&ch=br&gclid=Cj0KCQiA5dPuBRCrARIsAJL7oejWgk-kRRzIVjk_nt7xXY3-I5F_cYeHbltpDj4H7vba2QBjnQPwwiMaAqLVEALw_wcB
  8. Everyone loves a home-cooked meal. A personal chef who prepares meals in your home or theirs is an extravagant service. But put the idea out there. You never know . . . . A more affordable option is home-delivered meal kits. Home Chef, Blue Apron, and Green Chef are a few of the meal kit companies that allow you to choose meals that arrive with fresh, pre-measured and prepped ingredients, and instructions on how to create a fast meal.
  9. Massage is a wonderful way to relax and tune out the world. I highly recommend asking for a gift certificate to a spa that offers massage with hot stone and aromatherapy. You will emerge like a new person.
  10. One of the best gifts you could receive is respite care.  Do you have a relative or friend who could stay with your loved one a night or two so you can get away and totally tune out the world? If not, maybe one of they would generously provide you with a professional care service. Just imagine getting away from it all without any responsibilities for 24 or 48 hours.

You deserve gifts that will help you, the caregiver. So don’t be shy. When people ask how they might help or what you need or want, send them this list.

Have a happy, restful and peaceful Thanksgiving!


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at Barnes & NobleBoulder Book Store, Tattered Cover Book Store,  Indie Bound.org, and online at Target and Walmart, and many other fine independent bookstores, as well as public libraries.

What do you most remember/or miss about your loved one this Alzheimer’s Awareness Month?

christmas angel on blur bokeh city lights at night on background. Little white guardian angel in snow.As we honor our loved ones this Alzheimer’s Awareness Month of November, I invite you to submit:

  • a memory, poem, or tribute on how being a caregiver has changed your life
  • how having a loved one with Alzheimer’s disease has changed your life
  • a bit of advice that you’d like to share
  • just a memory

You can add it as a comment on this site, or send it to my email account and I will add it for you. Feel free to send a photo. calmerwaters410@gmail.com

I’d like to share something that my husband said to me three years before he passed away from younger-onset Alzheimer’s disease. This is in response to being asked what it’s like to have Alzheimers.

In Morris’s wordsMarch 2007

One time I feel one way and another time I feel a different way. I cope by finding things to do. I read, talk to people, go out to lunch with my friends. I feel just like anybody else, but I’m limited in things that I want to do, or where I want to go. I have to have someone take care of me. I would rather be my own person and do what I can do as much as possible. It’s not great having this [Alzheimer’s] and there’s not much I can do about it. But I do have lots of great friends and family, and I’m lucky to be able to think and act and live a partial life.

I’m not very happy at times. It’s not easy for me, and my wife tries to help as much as possible. I feel frustrated. I can’t have my car, which was taken away. I don’t have as many options. We have our TM lunch*; one of the things I look forward to. That’s a happy thing to do. Having people around is obviously good. I like watching movies and TV.

Sometimes I don’t know what to do, or I forget things and have to depend on my wife. I’ve had things taken away from me. When I first got the diagnosis, I thought it was a bunch of crap. I didn’t think the doctor had the right diagnosis and that I was pretty much okay. Now I understand that I have Alzheimer’s disease and things are more difficult. That’s the way it is. Having a support group is very important to me. Sometimes I get frustrated and sometimes I feel that I’m still a human being and that I can do things.

I know I’m taken care of.  I’m able to just be a good person that other people want to be around. I’m already enlightened in my own way. I feel like I’m my own being, my own person, and am living a life to the best of my ability. I like music and culture. I’m very lucky to have a support group of friends and family. In this life, I’m doing the best I can and I’ll continue to with friends and family.

I want to be treated like any other human being. My message to others is try to find your own happiness and do the best you can. I still like to meditate and I like to take a nap every day. I am getting more tired. I can’t do a lot or do as well as I used to do.

* About a dozen friends who practice Transcendental Meditation have been meeting regularly for lunch every Tuesday for the past 18 years.


This morning, I listened to an interview with the flutist Eugenia Zuckerman on NPR. Sadly, she was diagnosed with Alzheimer’s three years ago. This past September, Zukerman was playing Claude Debussy’s “Syrinx” — a piece she said that she’s played more than 20,000 times since the age of 10.  In the middle of playing it, she drew a sudden blank.

Eugenia said that she wants people to know that having cognitive decline is “not the end of the world.” At this early stage of the disease, she is able to write, play the flute, and enjoy her everyday life. Her recently published book “like falling through a cloud” is a lyrical memoir of poetry that addresses coping with forgetfulness, confusion, and a dreaded disease.

Eugenia spoke of living each day to the fullest—a definite mantra of mine and most people.  I am happy that she is enjoying her life by loving, sharing and playing her flute. But she doesn’t have a clue about what’s in her future. There will tragically come a time when her memory lapses manifest as blank stares. She may eventually not be able to recognize her face in the mirror and ask the existential question who am I? 

I wish you, and Eugenia’s family and friends peace and strength on the hard journey ahead. Make each day count and, as Morris said, live it as well as you can. There will be days that are hard to get through, and days where you just want to stay in bed. Even if you have to drag yourself out of bed, do at least one thing that will bring you an inkling of joy. Make a cup of chai, take an Epsom salts bath, light a candle. Take a whiff of your favorite essential oil. Remember the good times.

 


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Just because I’m having trouble with my short-term memory doesn’t make it OK to exclude me from discussions about me

Just because your loved one has dementia, please treat him or her as a thinking, feeling person who has feelings. Don’t disregard them or exclude them from conversation.

Dealing with Dementia

I’m writing this post recognizing that I’m really kinda angry. I know I can get a little “righteous” but I’m seeing families work around their loved ones instead of with them.

I know often, it’s easier to to just do things for someone. Please imagine how you would feel if you suddenly found yourself on the outside when choices about your health and finances were made for you?

Maybe you had a discussion about the topic, but for someone with short-term memory loss they won’t remember that, so are there other ways to help include and remind them of the discussion and decisions made? A notebook, email or texts?

I’m working with a new client and she told me she went to the bank to get a copy of her last statement and her son and POA had changed her statements to paperless. She knows she can’t recall the amount…

View original post 322 more words

Is it time to place your loved one on hospice care?

Elderly female hand holding hand of young caregiver at nursing home.Geriatric doctor or geriatrician concept. Doctor physician hand on happy elderly senior patient to comfort in hospital examinationDeciding if it’s time to place a loved one on hospice care is one of the most painful decisions any caregiver will make. After my mom broke her hip, she was put on heavy pain medication. I sat by her side for two weeks and witnessed her hallucinating about bugs flying in the air and seeing dead family members visit her. I thought they were coaxing her to follow them. I believed that she was dying, and her doctor advised me to consider placing her on hospice care. After talking it through with my brother, we agreed that this was the best thing to do.

Well, it ended up not being the best thing. The hospice team was giving her too many meds and my mother was dying from lack of hydration and food because her hospice caregivers were “snowing” her. They gave her too many pain meds and not enough liquids. She slept round the clock and didn’t wake up to eat or drink. When the private caregiver I hired me alerted me to what was going on, I took my other off hospice. She bounced back and lived another couple of years. She never walked again, despite making a whole hearted effort (that’s another story) and welcomed three great grandchildren into the family.

Several years before my mom died, she placed my dad on hospice care. He had an entirely different experience. The hospice team attentively provided care that my mother was incapable of, and he died with dignity.

The day my husband’s doctor suggested that I consider hospice care was a hard one. But I knew that his illness was terminal, and welcomed the extra attention and care that he would receive. At the very end, the loving and tender care that the hospice team showed him and me and my adult children was significant and so appreciated. They provided us with food and beverages, and aromatherapy cream to massage his legs and feet.

Whether your patient has a terminal illness, is getting toward the end of life, or is suffering from acute and painful symptoms, it’s important to know the difference between palliative care and hospice.

Palliative care

Palliative care is an umbrella of comfort and quality of life care which includes hospice care. It isn’t just used at the end of life, but can be very beneficial when the goal is complete healing and cure. Palliative care is not only end-of-life care. It can be used anytime during the course of an illness.

Defined by the National Hospice and Palliative Care Organization, “palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information and choice.”

The following points characterize palliative care philosophy and delivery:

  • Care is provided and services are coordinated by an interdisciplinary team.
  • Patients, families, palliative and non-palliative health care providers collaborate and communicate about care needs.
  • Services are available concurrently with or independent of curative or life-prolonging care.
  • Patient and family hope for peace and dignity are supported throughout the course of illness, during the dying process, and after death.

Any individual with a serious illness, regardless of life expectancy or prognosis, can receive palliative care. Additionally, individuals who qualify for hospice service, and who are not emotionally ready to elect hospice care could benefit from these services.

Patients receive the following palliative services in any care setting:

  • pain and symptom management
  • in-person and telephone visits
  • help navigating treatment options
  • advance care planning and referrals to community resources.

Hospice care

Hospice care provides comfort through the end of life when the individual has a terminal prognosis and no further curative treatments are pursued. Hospice care focuses on the pain, symptoms, and stress of serious illness during the terminal phase. The terminal phase is defined by Medicare as an individual with a life expectancy of 6-months or less if the disease runs its natural course. This care is provided by an interdisciplinary team who provides care encompassing the individual patient and their family’s holistic needs.

Hospice should be considered at the point when the burden of any given curative treatment modalities outweighs the benefit coupled with prognosis. Other factors to consider and discuss, based on individual patient situations, are treatment modalities that no longer provide benefit due to a loss of efficacy.

It’s important to know that even if someone is placed on hospice care, s/he may be kicked off after the six-month period if their health improves. Sometimes it’s just a matter of that person beginning to eat and gain weight instead of refusing food and losing weight. An individual might go off and on hospice several times.

Patients receive the following services in most care settings including home, hospice facility, skilled nursing facility, long-term care facility, assisted living facility, hospital (inpatient levels of care only), group home:

Pain and symptom management

  • 24-hour on-call service
  • in-person visits
  • medical equipment
  • related medications
  • inpatient care
  • continuous care in the home
  • respite care
  • volunteer services
  • spiritual care
  • bereavement and counseling services

What you need to know about hospice

To initiate the process, a consultation for hospice and/or palliative care is initiated by the primary care physician or specialist, the patient, or a family member. The consultation is important to provide the patient and/or family with the services provided, as well as to verify that the patient qualifies for the services based on their current health status. If the person qualifies and desires the services their care provider issues a medical order. The hospice or palliative care provider then assigns an RN as the case manager who conducts an assessment of the patient. The patient’s needs are identified and a care plan is created.

  • Hospice does NOT provide round-the-clock caregivers.
  • If the patient gets better and gets off hospice care, s/he might re-qualify for services if they are needed in the future.
  • The patient doesn’t have to go off all their medications. For instance, if it’s flu season, and especially if the patient is in a care facility, s/he will probably still get a flu shot to reduce risk of getting sick and getting others sick. If the patient is on quality of life medications, those can be continued, as well as pain management medications. For the patient who has been on thyroid medications for decades, s/he will remain on those medications.
  • If the patient is uncomfortable with the visiting nurse or CNA, who usually provides personal hygiene a couple of times a week, a new visiting nurse health aid can be provided. The nurse coordinates the patient’s care plan so it’s important that the patient is comfortable with this person.
  • Hospice usually provides the following supplies: bed pads, adult diapers, wipes, barrier wipes/paste, non-latex gloves, wheel chairs, commodes, pressure pads, walkers, shower and transfer benches, air mattresses, hospital beds, bedside tray tables.

You will probably have a choice between a non-profit and for-profit hospice. Consult first with Medicare and your additional insurance provider or with Medicaid to see what is covered and which hospice affiliates they recommend. The Medicare Hospice Benefit pays all related costs associated with the care that is related to the terminal prognosis as directed by Centers for Medicare and Medicaid Services (CMS). Most private insurers have a hospice benefit that pays all related costs associated with the care related to the terminal prognosis. In most states Medicaid pays all related costs associated with the care related to the terminal prognosis as directed by CMS. In all cases, there may be some medications, services and/or equipment that are not included in the Medicare, Medicaid or individual’s policy, so don’t assume anything. Always ask.

Please remember that the more help you have in caring for your loved one, the more comfortable it will most likely be for you and your patient. This is usually one situation in which the adage “too many cooks in the kitchen spoil the stew” doesn’t apply. The more people you have on your caregiving team the better. And if your loved one has a terminal illness, the sooner you research hospice and palliative care the better. Don’t wait until an emergency arises and you are in a panic about helping your loved one. Don’t do it alone. Get help.

Blessings to you and your family.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

What if your dementia patient becomes abusive, aggressive or violent?

Angry, enraged senior woman yelling at a landline office phone, unhappy with customer service provided by the agent on the other side, giving off steam and smokeMy husband Morris was a gentle man. But occasionally, if things didn’t go his way, he would get nasty. Once Alzheimer’s took his brain hostage, he exhibited a darker side. But only when he was frustrated or confused.

Morris spent the last two years of his life in a memory care home. He was popular among the staff because he liked to goof around. When he walked the halls listening to music on his Walkman, he’d have a smile on his face and swagger to the rhythm. But if another resident got in his way, watch out. If it was crowded in the dining room and someone accidentally bumped him, he’d swing his arm out to shoo that person away. When one of his neighbors walked into Morris’s room mistaking it for his own, the two got into a rumble on the bed and fought like school boys. After this happened a couple more times, the neighbor was moved to the opposite side of the facility.

When Morris hit a resident in the dining room, the on-call physician prescribed a depressant to “calm him down.” Morris reacted to the drug by transforming into a zombie who slumped in his chair and slept too many hours during the day. I insisted that he get off the drug and Morris returned to his mostly cheerful self.

I once had a next door neighbor whose wife had Alzheimer’s. She threatened to kill her husband with a knife and then went on to slash a painting hanging in their living room. Was she or Morris responsible for their actions? No. A person with dementia is not responsible for acts of violence because as the disease progresses, neurons in the cortex that are responsible for language, reasoning and social behavior are destroyed. This leads to some Alzheimer’s patients engaging in aggressive or violent behavior such as biting, kicking, spitting, slapping, punching, and/or using foul language.

Research from the National Institutes of Health indicates that up to 96 percent of patients with dementia who were studied over a 10-year-period exhibited aggressive behavior at one time or other. In 2011, CNN Health reported that 5 to 10 percent of Alzheimer’s patients exhibit violent behavior at some point during the course of the disease.

There is usually a reason for aggressive behavior.

What to watch out for

  • Urinary tract infection
  • Pain or stress
  • Loneliness, depression
  • Too much noise or stimulation
  • Boredom
  • Constipation
  • Soiled diaper or underwear
  • Uncomfortable room temperature
  • Physical discomfort (stomach ache, etc)
  • Confusion
  • Anger about loss of freedom (to drive, living independently)
  • Drug reaction or contra-indication
  • Resistance against being told what to do such as bathing
  • Sudden change in routine, environment or caregiver
  • Communication problems
  • Hunger or not liking the food
  • Dehydration

What to do

  1. If your life or the life of the person you care for is in danger, get help immediately!
  2. The Alzheimer’s Association has a 24-hour helpline at 800-272-3900.
  3. Rule out UTIs, pain, discomfort, etc.
  4. Use an essential oil to help calm the person down. When my husband got agitated I’d put a few drops of oil on a cotton pad inside a diffuser and plug it into the wall. He usually calmed down immediately.  The following oils can be used in a diffuser, or put in a bath or fragrance free moisturizer. They can also be sprayed on a pillow or handkerchief. Citrus oils are generally refreshing and uplifting for the mind and emotions, relieve stress and anxiety, and are useful for odor management and appetite support. Consider: bergamot, grapefruit, lemon, and orange. Floral oils are often used as a personal fragrance and are useful to relieve anxiety, depression, and irritability. These oils are useful as an inhaler, in a body lotion, and for the bath. Consider: clary sage, geranium, lavender, rose, and ylang ylang. Tree oils are revitalizing with immune boosting properties, ease respiratory congestion, and are supportive to breathing ease. They are useful for pain relief, skin infections, and odor management, and can relieve nervous exhaustion and depression. Consider: eucalyptus (Eucalytpus citriodora or globulus), pine needle, sandalwood, or Tea Tree.
  5. Reassure your patient by speaking gently and calmly.
  6. Play calming music, i.e. Mozart
  7. Try to distract the person with a TV show, favorite snack (ice cream almost always works), or a walk outside.
  8. Maintain a regular routine.
  9. Make sure the lighting is suitable in the home or facility.
  10. Help the person to maintain as much dignity and independence as possible.
  11. Make sure the person is eating a nutritious low-sugar, low-salt diet, with no or very limited amounts of alcohol and caffeine.

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

5 Things that Help Dementia that your Doctor Probably Hasn’t Mentioned

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Photo by Anastasia Dulgier

As a researcher and writer for manufacturers of nutrition supplements, I was in a unique position to care for my husband who was diagnosed with younger-onset Alzheimer’s disease right after his 60th birthday. Morris had opened and operated one of the first natural foods stores in Colorado in the late 1960s. After we married in 1974, I helped him run it. Working in a natural foods store was a natural fit for me because I had been a vegetarian for several years and was eager to learn more about natural health.

Later, I obtained a master’s degree in professional writing and my first job out of school was working as chief copy writer for a manufacturer of nutritional supplements. I learned a lot about supplements and ended up forming my own copy writing service. I learned how to interpret scientific studies, which especially came in handy when Morris was diagnosed with Alzheimer’s disease.

After the initial shock, I immediately went to work researching the drug protocol for Alzheimer’s. I discovered Namenda before it was FDA approved in the U.S. and ordered it from a European company. I gave Morris nutritional supplements, in addition to the prescribed pharmaceuticals, and butted heads with the neurologist who didn’t think that vitamins or minerals could possibly help someone with Alzheimer’s disease.

There have been some negative studies indicating that supplements don’t relieve symptoms of Alzheimer’s disease. But from what I can tell, they have been poorly designed and seem to be the fodder for sensational headlines. But there have also been many studies that show some dietary supplements can slow down dementia symptoms, and in some instances even reverse symptoms.

My purpose is not to convince you one way or the other. Rather, I encourage you as a caregiver to learn about dietary supplements and other modalities that have science backing them up.

  1. Souvenaid is a once-daily drink containing a mixture of long-chain omega-3 fatty acids, uridine, choline, B vitamins, vitamin C, vitamin E, and selenium) with some clinical evidence to suggest that it can benefit dearly Alzheimer’s patients. Doctors can prescribe it as a medical food in Australia and Europe, but it is not yet available in the United States. It is, however, available online. Read about the clinical evidence here: https://alzres.biomedcentral.com/articles/10.1186/s13195-019-0528-6

2. What about the use of cannabis for dementia? I live in Colorado where cannabis has been legal since 2014. Medical marijuana has been legal here since 2000. My husband smoked marijuana before it was in legal in Colorado to relieve his anxiety. He also ate “edibles.” It definitely calmed him down and made him happy, which may be the best outcome associated with cannabis. I did not notice any cognitive improvement.

This is the latest study on cannabis for dementia, published July 17, 2019.

 Limited evidence from one systematic review and one uncontrolled before-and-after study suggested that medical cannabis may be effective for treating agitation, disinhibition, irritability, aberrant motor behavior, and nocturnal behavior disorders as well as aberrant vocalization and resting care, which are neuropsychiatric symptoms associated with dementia.

There was also limited evidence of improvement in rigidity and cognitive scores as assessed by Mini-Mental State Examination. The evidence from the systematic review came from four of its primary studies, whereas its remaining eight included studies did not find favorable or unfavorable evidence regarding the effectiveness of cannabinoids in the treatment of dementia. Sources of uncertainty included the low quality of evidence in the primary studies of the systematic review and the fact that the uncontrolled before-and-after study was a nonrandomized pilot study in 10 dementia patients that reported descriptive outcomes without statistical analysis. No relevant evidence-based clinical guidelines regarding the use of medical cannabis for treating dementia were identified.

3. Vitamin D has been associated with memory loss and cognitive decline. Older adults with low vitamin D levels are at higher risk of dementia and may lose their cognitive abilities faster than those who have normal levels. This is one of the several reasons why everyone, except maybe those who work outdoors year-round, should take a vitamin D supplement.

4. Vitamin E includes several compounds: d-alpha tocopherol, high gamma tocopherol, mixed tocopherols and tocotrienols. Headlines have screamed that people who take more than 400 IUs of vitamin E have a 5 percent greater risk of death than those who don’t take the supplement. Unfortunately, the studies analyzed in this report used only alpha-tocopherol, a synthetic form of vitamin E. The studies were flawed in many other ways, but the important thing to understand is that when you take a full spectrum vitamin E, you are protecting your brain, your heart, and your overall health. A recent study looked at the relationship between tocotrienol and Alzheimer’s disease. Based on its ability to act as a free-radical scavenger, the authors concluded that it has the potential to help reduce risk of Alzheimer’s. https://www.ncbi.nlm.nih.gov/pubmed/29987193

5. I gave St. John’s wort to my husband until he was in late-stage Alzheimer’s disease. By then he needed a pharmaceutical anti-depressant. But the St. John’s wort worked well for mild to moderate depression.

Here’s what we know about St. John’s wort:

Pharmaceutical drugs usually come with a long list of possible side effects. Although some natural products can also have side effects, they are not as common and are usually less severe. One thing to note, though, about natural products is that it may take longer for them to be effective.

It’s always important to read and study when caring for a loved one. Become an informed caregiver. It will help you, your extended family and the person you so lovingly devote your time and energy to. Blessings to you.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Caring for a Parent who is Resistant to Care

Upset womanIt’s typical for our parents to resist moving out of their homes if they need to be cared for or need assistance in a long-term care facility. They may think their children are bossy and forcing them into a situation they didn’t choose. People, in general, are also often resistant to having an aid or personal carer other than family in their home.

A friend of mine had to move his parents, who were no longer able to care for themselves, into an assisted living facility. His mom had broken her hip and his dad was blind. After spending a couple of weeks settling them into their new home, David’s mom accused him of kidnapping her and his dad. In the end, after David returned home, his parents found a way to move back into their condo. There are bad feelings on both sides and now David and his parents are not speaking.

When the roles of parent and child are reversed, awkward moments and emotions can arise. The adult child may feel resentment at having to provide support and/or care for the parents because the extra time detracts from his or her normal routine and work schedule. Sometimes there is a financial burden placed on the adult child. The parents may feel disempowered when their freedoms are limited or taken away. They may feel financially stressed, and not want to “be a burden.”

Here are some ways to help you navigate this touchy and stressful subject.

  • Talk with your parents’ Primary Care Physician to get a clear picture of their physical needs.
  • Although you want your parents to be safe, above all else, respect their perspective and autonomy. Listen with an open heart and mind, and share your concerns. Tell them you know that this is hard, and that you are concerned about their welfare and safety.
  • Validate their feelings. Ask non-threatening, open-ended questions about the type of care they might be willing to accept. “Mom, wouldn’t it be great if you didn’t have to cook or do laundry anymore?” “Dad, do you miss having coffee out with your friends?” Their answers will provide you with the opening to a discussion about how a caregiver or assisted living situation can make their lives, and yours, easier.
  • If finances are an issue try to enlist the help of a close friend, neighbor or family member once or twice a week for a couple of hours to assist with meal preparation, etc.
  • If this works and your folks get accustomed to having someone in their home, hire a caregiver agency to provide more care as needed.

What if you’ve tried everything you can think of and your parent is still resistant to help. Or what if your sibling wreaks havoc on what you’ve done?

If you sincerely believe that your parent’s behavior is contrary to what they typically exhibited previously; if they are unsafe in their home or are a danger to them self or others; if you have considered their dignity with respect, and you believe that their mental capacity is impaired as well as their decision making, you can activate a Medical Power of Attorney (MDPOA).

This is a legal document that authorizes someone to make medical decisions on behalf of another, only if one is already in place. If one is not in place and things are getting dire, consult with an elder attorney to determine if it makes sense to have a court appointed guardianship. This would be a last resort.

Most importantly, treat your parents with respect and honor their wishes the best that you can, always keeping their safety as a priority. Most everyone wants to stay in their home as long as possible. It’s hard bringing up this topic with our parents, but the earlier the better, especially when one of your loved one has dementia.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

 

 

 

 

Did you know that napping can be an early Alzheimer’s warning sign?

Tired.

Senior sitting and sleeping. 

Researchers at the University of California (several campuses), and University of Sao Paulo recently found that if you need to nap more than usual, and if your nap time is getting longer than it used to be, it might be an early warning sign that you could develop Alzheimer’s disease.

Even if they’ve had a full night’s sleep, many people with Alzheimer’s will sleep a lot during the day. Now, based on this new finding, researchers are considering that examining daytime napping might help predict the future onset of Alzheimer’s disease.

The researchers were concerned about what comes first: sleep changes that play role in the development of Alzheimer’s or if changes in a person’s sleep pattern is indicative of the beginning of Alzheimer’s.

Dr. Lea Grinberg, senior author of the findings, which appear in the journal Alzheimer’s & Dementia, explains that her team found evidence that an entire network of neurons that keeps us awake is wiped out by the accumulation of tau proteins which form tangles that disrupt communication between brain cells.

The researchers studied postmortem brain tissue of 13 deceased Alzheimer’s patients who had donated their brain to research and compared them to others without the disease. They found that in the Alzheimer’s brains the three areas of the brain that keep us awake (the locus coeruleus, the lateral hypothalamic area, and the tuberomammillary nucleus) had lost 75% of their neurons.

Researchers found “considerable amounts of tau inclusions” in the awakening areas of the brain, the study said.

Tau is a protein whose normal function is to stabilize a particular part of the neuron in all species. In the brain of someone with Alzheimer’s, tau acts abnormally and destabilizes the neuron. The build-up of tau protein is one of the main culprits of Alzheimer’s disease.

The researchers said that it’s unclear how long it takes to notice memory loss after sleep pattern changes occur.

Sadly, the study’s lead author Jun Oh said in an article by Maria Cohut published in Medical News August 18, 2019, said that “It’s remarkable because it’s not just a single brain nucleus that’s degenerating, but the whole wakefulness-promoting network. Crucially, this means that the brain has no way to compensate because all of these functionally related cell types are being destroyed at the same time.”

As a result of this study and one in the past, she said, they have received funding to keep looking into changes in sleep patterns before memory loss begins.

The NIH and Rainwater Charitable Foundation are investing $1.4 million per year to this research group to continue their research into other areas of the brain responsible for promoting sleep and the areas that regulate circadian rhythm, as well as sleep pattern changes that occur before memory loss begins.

Until we know more, if napping is a normal part of your routine,  you don’t have to worry about taking a mid-day or mid-morning siesta. But if your pattern has changed, it might be a good idea to make an appointment with your physician to discuss your sleep habits and to rule out other medical conditions.

In the meantime, make sure your sleep hygiene is optimal. Click here for 16 ways to sleep better.

Good night, sleep tight.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

The 20 most important things to consider when looking for a memory care home

seniorenheim 6The day I moved my husband into a memory care home was the second worst day of my life. The worst day was the day he was diagnosed with Alzheimer’s. And both of those days were worse than the day he died.

After the diagnosis, I didn’t waste any time getting our finances sorted out, talking to an elder attorney about options, and learning about Medicare benefits. I did, however, wait a year before I contacted that Alzheimer’s Association. That was a mistake because this amazing association offers so much good information and support. So do yourself a favor and contact your local chapter and take advantage of all the free classes and support groups they offer.

After several years of caring for my husband at home, and downsizing to a more manageable home, I was advised to start looking for a memory care home in case an emergency situation arose.  I wanted to keep my husband at home as long as possible. But things happen, and in my case, I received a serious diagnosis. My doctor said that I needed to take care of myself and I listened to him. I got recommendations about a few homes in my town, found one I liked, and put my husband on the waiting list.

Many facilities will allow you to get on a waiting list. When your name gets to the top, you might have the option to refuse because you are not ready. In this case, you can move down the list but still have priority over someone who is recently added. Ask about this option.

The home where my husband lived for two years provided good care, but did not live up to the promise of caring for him until the end of his life. In fact, the last month of his life included several moves. After being discharged from the hospital, Morris was sent to a rehab center in a nursing home. It was not a good situation. The food was horrible, and the care was sorely inadequate. After two weeks, I begged the original home to take him back. They agreed to only if I hired additional one-on-one care. I did, but the cost was prohibitive. I moved him again after finding a wonderful end-stage Alzheimer’s unit down the hall from a hospice center. Morris received excellent compassionate care there the last two weeks of his life.

Here’s list of 20 things to look for and ask in your search for a memory care home:

  1. Look at your state’s Public Health and Environment website to see a facility’s number of beds, complaints, medical director, ombudsman’s phone number, and whether the home is Medicare and/or Medicaid certified. Here you can discover things like mishandling of narcotics (oxycodone), and theft of residents’ belongings, etc.
  2. What is the staff to patient ratio? During the day? At night?
  3. Is there a RN (registered nurse) always on the premises? Is a doctor always on call?
  4. How often does a medical doctor visit the facility?
  5. What level of care does the home provide? Can your loved one stay there until the end of his/her life? What if your loved one becomes non-ambulatory?
  6. Are three meals a day provided? What about special diets such as kosher, vegetarian, low-salt?
  7. What type of training has the staff received?
  8. What is the staff turn-over rate?
  9. What is the monthly rate for housing and care? What services does that rate include?
  10. Are rooms private or semi-private? How do prices vary for each?
  11. Is housekeeping and laundry provided? How often?
  12. What programs are offered? Social, educational, outings, exercise?
  13. How secure is the unit? Are residents locked in? Is there any chance a resident can leave and wander? Has this ever happened?
  14. What happens if the resident becomes aggressive or violent? Is he or she drugged? Given a warning that he or she must move out?
  15. What is the chain of communication for letting family members know what is going on with a loved one?
  16. What is the discharge policy?
  17. Are pets allowed?
  18. Are visiting hours limited or open?
  19. What is the protocol for a medical emergency?
  20. Visit the facility and look around. Are the staff appropriately dressed? Are they warm and friendly? Is the environment pleasing and clean? Does the executive director address residents by their name? Would you be comfortable having your loved one live there, and would you be comfortable spending many hours there?

No one ever wants to live in a nursing home or assisted living facility. But when your loved one needs more care than you can provide, is a danger to him or herself, or you, the caregiver, need to take care of yourself, a memory care home can provide a warm and loving option. Good luck finding one that suits your needs and the needs of your loved one.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.